A Multilevel Framework for the Promotion of Maternal Mental Health and Well-Being During the Perinatal Period.

Background: Depression and anxiety are prevalent in the perinatal period and may contribute to adverse maternal and child health outcomes. A focus on multilevel protective factors may be effective in promoting well-being and increasing quality of life (QOL) in the perinatal period while simultaneously reducing or preventing depression and anxiety symptoms. We tested a conceptual model that posits specific personal, social, and community factors affecting depression, anxiety, and QOL among pregnant and postpartum individuals. Methods: Four hundred and thirty-eight pregnant or postpartum individuals completed a 121-item cross-sectional survey composed of validated tools that assessed multilevel protective factors, health behaviors, and mental health outcomes. Confirmatory factor analysis (CFA) was constructed to evaluate a 3-part conceptual model against measured indicators of well-being. A structural equation model (SEM) was then fit to test the pattern of associations between our latent structure and three end points: depression, anxiety, and QOL. Results: The CFA fit the data well (comparative fit index [CFI] = 0.907, Tucker-Lewis index [TLI] = 0.876, root-mean-square error of approximation [RMSEA] = 0.092) supporting the proposed conceptual approach to measuring well-being. The SEM fit well (CFI = 0.964, TLI = 0.941, RMSEA = 0.059), and all three end points were predicted in the hypothesized direction. Social factors predicted reduced anxiety symptomatology, personal and community resources predicted reduced depressive symptomatology, and social resources predicted increased QOL. In addition, we found that collective community resources were associated with social and personal resources, and social resources directly affected personal resources, showing the benefit of multiple levels. Conclusions: Our findings suggest that both the collection of and interplay between certain personal, social, and community-level resources may prevent and protect against depression and anxiety and promote QOL. Our conceptual model provides a framework to inform future interventions and clinical practice to better assess and promote maternal well-being during the perinatal period.